Flu forecasts using weather, not climate

BOULDER—Scientists at Columbia University and the National Center for Atmospheric Research have adapted techniques used in modern weather prediction to generate local forecasts of seasonal influenza outbreaks.

People wear face masks in Mexico during a 2009 outbreak of the flu. Scientists have created a pilot system to forecast flu outbreaks. (Photo by Henry Merino, Wikimedia Commons.)

By predicting the timing and severity of the outbreaks, this pilot system can eventually help health officials and the general public better prepare for them.

The study, published this week in the Proceedings of the National Academy of Sciences, was funded by the National Institutes of Health and the Department of Homeland Security. NCAR’s sponsor is the National Science Foundation.

From year to year, and region to region, there is huge variability in the peak of flu season, which can arrive in temperate areas of the Northern Hemisphere as early as October or as late as April. The new forecast system can provide “a window into what can happen week to week as flu prevalence rises and falls,” says lead author Jeffrey Shaman, an assistant professor of Environmental Health Sciences at Columbia’s Mailman School of Public Health.

In previous work, Shaman and colleagues had found that wintertime U.S. flu epidemics tended to occur following very dry weather. Using a prediction model that incorporates this finding, Shaman and co-author Alicia Karspeck, an NCAR scientist, used Web-based estimates of flu-related sickness from the winters of 2003–04 to 2008–09 in New York City to retrospectively generate weekly flu forecasts. They found that the technique could predict the peak timing of the outbreak more than seven weeks in advance of the actual peak.

“Analogous to weather prediction, this system can potentially be used to estimate the probability of regional outbreaks of the flu several weeks in advance,” Karspeck says. “One exciting element of this work is that we’ve applied quantitative forecasting techniques developed within the geosciences community to the challenge of real-time infectious disease prediction. This has been a tremendously fruitful cross-disciplinary collaboration.”

Up next: your local flu forecast

In the future, such flu forecasts might conceivably be disseminated on the local television news along with the weather report, says Shaman. Like the weather, flu conditions vary from region to region; Atlanta might see its peak weeks ahead of Anchorage.

“Because we are all familiar with weather broadcasts, when we hear that there is an 80 percent chance of rain, we all have an intuitive sense of whether or not we should carry an umbrella,” Shaman says. “I expect we will develop a similar comfort level and confidence in flu forecasts and develop an intuition of what we should do to protect ourselves in response to different forecast outcomes.”

A flu forecast could prompt individuals to get a vaccine, exercise care around people sneezing and coughing, and better monitor how they feel. For health officials, it could inform decisions on how many vaccines and antiviral drugs to stockpile, and in the case of a virulent outbreak, whether other measures, like closing schools, is necessary.

“Flu forecasting has the potential to significantly improve our ability to prepare for and manage the seasonal flu outbreaks that strike each year,” says Irene Eckstrand of the National Institutes of Health’s National Institute of General Medical Sciences.

Worldwide, influenza kills an estimated 250,000 to 500,000 people each year. The U.S. annual death toll is about 35,000.

The seed of the new study was planted four years ago in a conversation between the two researchers, in which Shaman expressed an interest in using models to forecast influenza. Karspeck “recommended incorporating some of the data assimilation techniques used in weather forecasting to build a skillful prediction system,” remembers Shaman.

In weather forecasting, real-time observational data are used to nudge a numerical model to conform with reality, thus reducing error. Applying this method to flu forecasting, the researchers used near-real-time data from Google Flu Trends, which estimates outbreaks based on the number of flu-related search queries in a given region.

Going forward, Shaman will test the model in other localities across the country using up-to-date data.

“There is no guarantee that just because the method works in New York, it will work in Miami,” Shaman says.

I guess immunology and nutrition isn’t their strong suit. The reality is that we don’t get enough vitamin D during the winter.

PLUS, we tend to stay inside more and get less fresh air.

I can tell you this, I won’t take vitamin D supplements or any vitamins at all. Unless you get your vitamins by food, most of it leaves your body when you pee. I’ve only gotten the flu twice in my life. I practice good hygiene but I don’t overdo it like some do. But when I was a kid, I got sick a lot, just not the flu. I think that is the reason why I don’t get sick often now.

“…real-time observational data are used to nudge a numerical model to conform with reality…”
———————————–
Instead of subjective biases nudging models to conform to an agenda? What the hell kinda scientists are these!?!

I know many will take me to task for being so heartless but 35 thousand out of 350 million, its a fair trade. I am concerned about the methodology. It seems that estimating humidity seven weeks in advance is about as good as estimating my golf score for the next round. Just a reminder that correlation is not causation and we had better be sure the collaborations are meaningful.

I can endorse the first comment, by ‘nerd’…and immunology and nutrition IS my strong suit — I earned a PhD in immunology and medical microbiology at Stanford back in the 1970s. Dr. Cannell at the vitamindcouncil considers that most people need about 5000 units per day, which means the traditional advice is about an order of magnitude too low. And, many conditions are helped by keeping calcidiol (the first metabolite of D3 made in the skin or taken as a supplement) levels at about 50 nanograms per ml. The conventional standard is 30, and very many people that reside in the higher latitudes are deficient even by that standard. Dark skin and obesity are also risk factors. Older skin is only half as good as that of younger people in the initial production.

You cannot get enough D3 from sunshine in the winter unless you reside in the tropics. If your shadow is longer than you are tall, the UV is not high enough. Dr. Cannell first became aware of the flu aspect when he gave a ‘high’ (actually the correct) dose to a ward of institutionalized patients at a state hospital who did not get any sun. His ward escaped the flu season.

There has been an explosion of research in recent years, and the other major website on D3, the vitamindwiki, has a chart on the home page that shows how many papers have been published versus the year. There is still a need for more randomized controlled trials (RCT) to convince the older docs, who were taught that ‘high’ doses are toxic. The semi-official Institute of Medicine (IOM) is still under the influence of ultra-conservatives who think that only bone health is influenced by calcidiol levels.

The conventional combination vitamin pill has too much vitamin A relative to the D3, according to Cannell — apparently there is some competition for uptake. The Weston A. Price foundation is more positive about vitamin A and thinks that both are needed for flu resistance. You can google the Price foundation for more info on that point.

The vitamindwiki has more data and links — about 3000 pages — but Cannell is probably the better source for most people. Note his commentary on traditional claims of toxicity, the need for co-factors such as vitamin K2, etc. There is a section on specific medical conditions. He has also published a popular book to spread the word.

Flu is more common in the winter because the gel-like coating that protects the inner virus from dying on a surface stays intact at lower temperatures and breaks down at warmer temperatures allowing the live virus to die from exposure, put in overly simple terms.

35K deaths a year. Not by a longshot. That CDC figure is a combined number between pneumonia and influenza deaths. If you turn to the next page in the CDC report they break it down to the details. Less than 1000 deaths due to flu and more than 34K deaths due to pneumonia.

But when you’re trying to scare people about the flu….. it’s OK to be off on the details by 3400%.

Interesting. People might want to google “Google Flu Trends” if they’re not familiar with it. It generally seems to do quite well with indicating where things are at in various states of the US at the moment.

The numbers we do have don’t even come close to the computer estimates. In Statistics Canada’s “deaths and mortality” table, under “cause of death: influenza,” there were only about 300 deaths a year between 2000 and 2008. Public health officials don’t trust that number. They believe it underestimates the true death toll from flu.

But Jefferson believes the models overstate the risk from influenza. “There are no real figures on deaths from influenza. They don’t collect that information,” he said. “So if they don’t collect that information, how do they know it’s a threat? And if they don’t collect that information, how do they know that their policies will work? This is called faith-based medicine, not evidence-based medicine.”

Michael Osterholm with the university’s Center for Infectious Disease Research and Policy looked at more than 12,000 peer-reviewed publications, documents transcripts and notes dating back to 1936. His team of researchers found that during some flu seasons the vaccine was not as effective, especially for the elderly.

“We found that current influenza vaccine protection is substantially lower than for most routine recommended vaccines and is suboptimal,” Osterholm said.

The three year study found the injectable trivalent inactivated influenza vaccine protects adults at a rate of about 59 percent and didn’t offer much protection to children or seniors.

Published cases of toxicity, for which serum levels and dose are known, all involve intake of ≥ 40000 IU (1000 mcg) per day. 1 Two different cases involved intake of over 2,000,000 IU per day – both men survived.

This study makes no sense. 2 points:
1: calls to 9-11 are a better indicator of what is hitting us than hits to google.

A more immediate and local measure of flu outbreak is needed. 9-11 is it. Another source is emergency room visits.

These indicators of attack rate are not utilized simply because we have not grasped the value and developed the system.

9-11 is seen as a low-level public service. This is empirical truth. Look at the avg salary, turnover, and educational level of 9-11 operators. They are fine, doing a noble job. It is us, the community, that are failing. Failing to realize that 9-11 calls and ER visits tell us what is going on. We do not have coordinated local systems.

2nd:
There is a lag time between getting flu shot and developing imunities to flu.
This is a go/no go question.

Are people going to honestly think: humidity has gotten to or below [critical level]; therefore I will immediately act to achieve immunity in [time span] days.

Oh great, yet another data-mining exercise – and when flu comes at the ‘wrong’ time, I suppose they will put it down to the fact that they haven’t yet incorporated AGW in their model (p.s. can we have some more money for that purpose?!).

Living in Mexico, I have two recurrent health problems: intestinal / food poisoning issues (even after 18 years here), and flu (not colds), far more than when I lived in my native, cold and wet, UK. If we can improve understanding and prediction of flu outbreaks, great! Viruses are very weird, and RNA viruses like influenza even more so than DNA ones. This research is not, of course, absolute truth, but I would say, welcome and interesting.

“Flu is more common in the winter because the gel-like coating that protects the inner virus from dying on a surface stays intact at lower temperatures and breaks down at warmer temperatures allowing the live virus to die from exposure, put in overly simple terms.”

Interesting ! Do you have a link? It would explain the funny situation that we all know the flu is a virus infection, and yet you tend to get it when it’s cold. When you mention the virus, there are all kinds of ecplanations, like, people tend to cluster “inside” when it is cold, and so on.

But here we have a scientific explanation/theory that sounds reasonable. Again; Link?

However, another study concluded that “while Google Flu Trends is highly correlated with rates of ILI, it has a lower correlation with surveillance for laboratory-confirmed influenza.”
I found these with a search in Bing using “google flu trends” correlation as my search terms; there looked to be several other studies in the search results, but I didn’t have time to look at more than these two. Acronyms: GFT = Google Flu Trends; ILI = influenza-like illness (“ILI is defined as a fever ≥37.8°C and a cough and/or a sore throat without known etiology”); ED = Emergency Department.

I read the article on the upcoming cold snap in the UK; temps in December may get to -20 C (4 degrees F), not 20 C (68 degrees F); it was misquoted early in the article and corrected later on. As for the humidity-flu link: How long does the dry spell need to last in order to trigger a flu outbreak? I think the incidence of flu still has a lot to do with contagion, crowds, people going to work sick or sending children to school sick, and the like; most cannot avoid going to work or school simply because others are likely to be there who have gone there not feeling well. I can see it now: Worker calls boss and says, “The flu forecast predicts a high contagion level today, so I’m staying home.” Boss: “Your last paycheck will be mailed to you; with a high unemployment rate, I’m sure I can replace you right away. Thanks for the warning!”

Flu and infectious diseases are merely Mother Nature’s right hand man at work. We need harsh weather to cull out the schtumpig. Better, live on a cold, poor island of old fisherfolk, they know how to live and when to die.

“tended to occur following very dry weather” Dew point plunges here mid to late November. Without moisture in the air to retain heat, temperature dives when the sun goes down. This extremely dry situation lasts til about March. Meteorology, it’s called “winter.”

I find it hard to believe that any one in the country would do anything differently if they were told that the seasonal flu outbreak was going to occur in 7 weeks. Even if it were believed to be 100% accurate, it wouldn’t change anything.

Lastly, hygiene is important, regardless of time of year or specific threats. Though it would be just like Stephanie Abrams to tell us to start washing our hands because a flu outbreak is pending.

Logan in AZ says:November 27, 2012 at 7:58 pm
Perhaps you can point me to an information source. I am interested in the affects of D3 on sarcoidosis granulomous. I have scavenged PubMed, learning that in the past decade or so, Williams et al 2001, seemed to first mention that D3 exacerbates sarcoisosis. It seems the D3 is used by the cells that differentiate between self and not self, I’ve not found explicitly how. Later abstracts appear to confirm the D3 connection. Avoiding D3 seems to alleviate or minimize the sarcoidosis. Are there any further information sources?

This was my reaction. Data mining produces all types of low p-value results. Remember there’s a 5% chance that any correlation with a p-value of less than 0.05 will be a coincidence. If 20 correlations are explored, then it should be expected that one will be a coincidence.

It’s impossible to back test something when all of the back data has been used to find a high correlation. I, too, am curious about the predictive ability of this model.

It’s a pity the paper was submitted in May 2012 and approved in October, otherwise we could have all had the benefit of their actual predictions for peak flu season this winter.

Still, I sure we can expect to see these predictions, and monitoring of their accuracy and usefulness, in the mainstream media. Probably about the same time as Foster and Rahmstorf publish some notable, verifiable temperature predictions with all appropriate definitions and dates.

The question is, given the same environmental circumstances, why do some people get the flu and others not? A robust immune system is key. For that, people have to ask, what is good health? I for one am very skeptical about the claims of the efficacy of high-doseage D supplements (i.e. 5,000 IU’s). I do believe good dietary and exercise (particularly outdoors) practices to be keys. Some vitamin supplementation may be beneficial as well. I do take a Vitamin A (10,000 IU) and D (400 IU) capsule, but not every day, perhaps three times a week. I haven’t had the flu in perhaps 40 years or more, nor have I ever had a flu shot.

Great bit of research from Dr Jackson on the “healthy user” problem and seasonal influenza. Turns out that the vast majority of the benefits claimed for the seasonal influenza vaccine are due to the healthy user effect. So you are way better off looking at other ways like hand washing and vitamin D3 supplements.

As to vitamin D (really a hormone, not a vitamin) it is vital to get enough as some very good research is showing. The sun needs to be above 50 degrees for the UVB to get through to you at ground level. That is both seasonally and daily. So if you live above the 35th parallel north you are looking at May to September and 11 AM to 2 PM. If you are going to supplement then make sure you are getting the D3 form not the D2. The D2 form is more stable so it is prescribed and in milk etc but the D3 is better utilized by your body.

I like google flu trends and think if they could tie in a few more feedback loops it would be great. Problem is the old correlation vs causation one. People scouring the web doesn’t mean they have it. Same with the weather but interesting approaches to a problem.

It is not a medicine blog here. But anyway: Vitamin D plays a decisive roll. For those who want some earnest medicine-stuff try this article (it is real science):http://www.virologyj.com/content/5/1/29
Believe it (or better not): I just attended an examination in a german Backward-Cimate-School near Berlin with the Professors Sourcreamtorf and Bellhuber. The pupil Felix K. Calculus was asked to tell the temperature if it was 27° C and increased 11° C. His result: 49° C. Prof. Sourcreamtorf remarked: That’ s completely wrong, my dear, it’s much too high. But Felix insisted. He declared, that his result was higher than expected and thus it was much better. Prof. Belllhuber agreed immediately. Yes! he exclaimed, it is indeed much higher than predicted in the lessons. Therefore it’s much better too! It is that way that climate-mathematics work. Prof. Sourcreamtorf acknowledged his mistake. So Felix became best of the class.

b a cullen, you’re correct, UVB.
This presentation by Dr. Holick is quite entertaining. It’s the keynote address he gave at the 34th European Symposium on Calcified Tissues in Copenhagen.http://www.uvadvantage.org/portals/0/pres/

Interesting that the time when people can benefit most from the sun to produce Vitamin D is the time the skin cancer scare lobby have virtually banned schoolchildren in Australia from going outside without full sunscreen or clothing protection. And, adults that work outdoors are increasingly being made to cover up because their employers are told they could be sued if an employee gets skin cancer.

Gail wrote, “it is amazing the expertise … that comes crawling out of the woodwork no matter what the subject.” True, but we should remember that Anthony’s asked us to generally remain on climate topics. Hmmm… although I guess we could argue that all those fluey people running high temperatures might contribute to global warming…

Yes, there are extensive but controversial sources on this and related topics. The background remark is that chronic infections that our immune response finds difficult to control (TB, leprosy) can produce a granuloma that contains cells (activated macrophages) which convert too much of the calcidiol pool to the active calcitriol, producing a toxic state (hypercalcemia). The macrophages try to ‘wall off’ the bacteria that are hard to kill.

The Cannell critique is not the last word, and the Marshall Protocol is more extensive than a concern for calcidiol conversion to calcitriol. Trevor Marshall has an elaborate theory about the role of cell wall deficient (CWD) bacteria and autoimmune conditions. CWD organisms are hard to detect and often difficult to culture. The big names on CWD or ‘L-form’ bacteria are the late L. H. Mattman and the retired Gerald J. Domingue. There are short wikipedia articles on Mattman and Domingue. Medline papers by a certain author can be found by entering, say,
domingue gj [au]
There is a book by Lida Mattman — Cell Wall Deficient Forms, Stealth Pathogens. You might find it in a large university library — the third edition was the last. It can also be purchased from Amazon for a high price.

I don’t know if there is an impartial evaluation of Marshall’s therapy. I only see two articles by Marshall on Medline, but he has written much more that has not been indexed. You will have to do some homework to judge such a controversial issue.

“Flu is more common in the winter because the gel-like coating that protects the inner virus from dying on a surface stays intact at lower temperatures and breaks down at warmer temperatures allowing the live virus to die from exposure, put in overly simple terms.”

Interesting ! Do you have a link? It would explain the funny situation that we all know the flu is a virus infection, and yet you tend to get it when it’s cold. When you mention the virus, there are all kinds of ecplanations, like, people tend to cluster “inside” when it is cold, and so on.

But here we have a scientific explanation/theory that sounds reasonable. Again; Link?

FWIW, the Zilla 25 (a 13 Watt CFL) runs about $22 on Amazon. Yes, I know, it’s placarded as ‘only for lizards and reptiles and don’t even think about it if you are a human’. So call me a lizard. It works for me… then again, it’s not used for 12 hours a day as on a lizard and we use eye protection – even though likely not needed. Plain old glasses absorb UV, or just sit with your back to it. You can get a sunburn in about 40 minutes to an hour with your back less than 2 feet from the bulb; provided you have pasty white transparent skin like me ;-). I deliberately did that test, in increments, to establish guidelines for the spouse… 4 feet and less than 20 minutes…

Maybe we’ll go blind or die of skin cancer or ‘whatever’, but at least we’ll be happy ;-)

(The spouse has the doctor do Vit-D assay every so often to monitor how she’s doing, so it’s not quite like we’re flying by the seat of our pants here… Taking the oral form didn’t get her assay up enough. Yes, there are commercial S.A.D. lamps. They are not significantly different, near as I can tell. Some more visible / blue and often less effectively controlled for enough UV or sometimes too much UV. It’s still an ‘evolving science’. Personally, I think the lizard folks have done more, in more detail, longer duration… The Zilla lamps now have a detailed spectrum chart on the package with power ratings by spectrum. Nice.)

Oh, and your LED lamps often put out too much blue in just the spectrum that resets your biological clock. So if you put in LED lamps and now find you stay awake late at night…

We now use the LED bulbs in the morning and swap to ‘yellower bulbs’ in the evening and all is well… ( I have a stash of incandescent bulbs… now that ‘curly bulbs’ are mandated in California. Expect as LEDs spread and more “daylight type’ CFLs enter use we’ll have a lot more sleepless irritable people. Note that we discovered this AFTER converting to LEDs… so it’s not like I was resisting them…)